Physicians and patients taking on the opioid crisis together

The practice of prescribing opioid drugs to patients following surgery has been the go-to standard in an environment where zero pain in recovery is the expectation. But with the fallout of opioid drug overuse painful to communities across the nation, both providers and patients are looking for alternatives.

Anesthesiologists from Old Pueblo Anesthesia, who practice at TMC, have been working to enhance their regional anesthesia program to provide additional options for patients. If patients can keep opioid use to a minimum in those crucial first days after surgery, while reducing their pain and inflammation, the hope is that they can use fewer narcotics through their recovery period.

Shoulder surgery, for example, is notoriously uncomfortable for some patients because the shoulder is engaged when a patient is standing or when laying down. Traditional anesthesia only lasts about 24 hours.

Now, in addition to direct injections to numb the area and block pain during surgery, physicians can place tiny catheters near the nerves that supply the shoulder with a local anesthetic to provide greater comfort for up to 3 days. The patient can care for the pump at home and throw it away when the anesthesia is depleted.

Dr. Robin Kloth said that Old Pueblo performed a comparison of patients with total shoulder replacement who used traditional pain relief and those who used interscalene catheter placement. “Over the course of the full 3 days, the catheter patients took less than half the narcotics that our compared group took in just a single day,” she said, adding patients also reported far less nausea.

Dr. Neesann Marietta concurred. “These techniques can really extend a patient’s pain relief, which greatly increases patient satisfaction. They can go home and sleep comfortably, which is so important for the healing process.”

And that’s just one example. For abdominal surgery, patients relied previously on epidurals that could only be used during their hospital stay. Now, anesthesiologists can do a block that provides local relief in the abdominal wall that will last up to 24 hours, and patients may be sent home the same day.

Colorectal and gyn-oncology surgeons are increasingly using a slow release local anesthetic that lasts up to 72 hours.

The colorectal program reports that between greater patient education, early ambulation and regional anesthesia, patients are seeing a decrease in patient length of stay by 1.3 days and an 88 percent decrease in morphine equivalent, given in the first 24 hours post-surgery.

“Both doctors and patients are becoming increasingly aware of the potential for the misuse of highly addictive pain medications and it’s important that we be part of this national discussion,” said surgical oncologist Michele Boyce Ley, who uses regional anesthesia as well as nonsteroidal medications such as Celebrex and gabapentin to help control pain for her patients having breast surgery.

Ley said her patients are doing so well, many are managing post-surgical pain with little more than Tylenol or ibuprofen.

“We have been working on this in earnest and getting training on these techniques because of concerns about opioid usage,” Kloth said. “Opioids have been the go-to solution for many years, in part because patients had high expectations of pain relief and because a bottle of Percocet is really cheap. These techniques are more labor intensive, but we’ve demonstrated value to the patient – and it’s the right thing to do,” she said.

Many patients also feel less lucid and less awake when using narcotics, which could delay physical therapy and rehabilitation.

Physicians have several opportunities to manage the use of narcotics, particularly important as patients leave the hospital with a plan for pain management during recovery.

Marietta said the techniques are not right for every patient and every case, but patients who are concerned about the potential for opioid misuse should have a conversation with their physician about pain control – and see if a nerve block would be appropriate.

Meet with Drs. Marietta, Kloth and Lambert Wednesday, November 15 as they discuss how anesthesiologists and patients can address this in practical terms at TMC for Seniors. More details available here.

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About TMC

Tucson Medical Center, licensed at more than 600 beds, has been Tucson’s locally governed nonprofit regional hospital for more than 70 years.

TMC is Southern Arizona’s leading provider for emergency care and pediatric care (including Tucson’s first Pediatric Emergency Department), with top-notch intensive care units for adults, children and newborns.